Volunteer/Intern Application
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Joanie Braun, Volunteer & Intern Manager
612-767-6680 [email protected]
Harriet Tubman Center West
3111 1st Ave. So.
Minneapolis, MN 55408 Fax: 612-825-6666
Katie Massie, Volunteer & Intern Coordinator 651-789-6752 [email protected]
Harriet Tubman Center East
1725 Monastery Way
Maplewood, MN 55109 Fax: 651-770-5506
Date:
Ms.
12/13/13
Name (First)
Gender:
Mrs.
Miss
(Middle)
Male
Female
Mr.
Dr.
www.tubman.org
Other
(Last)
Other
Decline
(Nickname)
Date of Birth:
Unit Number
Street Address
County
City
Zip Code
State
Email:
Home Phone
Work Phone
Cell Phone
Alternate Email:
Would you like to receive electronic updates from Tubman, including news, special event information, solicitations?
Yes
No
Specific Position in which you are interested (if known):
I'm interested in working with:
Children and Youth
Additional Skills:
Adults
Language
Facilities
Computer
Special Events
Administrative
Public Speaking
Legal Services
Other
Explain:
Do you have any previous volunteer or other applicable work experience? Please Describe:
Do you have any medical conditions that would affect your ability to perform your volunteer/intern duties, or that we should be aware
of? If yes, please explain:
Yes
No
Have you volunteered in the past at any of the following organizations?
Family Violence Network
Harriet Tubman Center
Tubman Family Alliance
Chrysalis
Availability (Please mark "X" on the times you could be available for a volunteer/intern assignment.)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Evening
Level of commitment required for most positions is a minimum of 4 hours per weeks for a total of at least 150 hours.
How long are you able to commit to volunteering at Tubman?
How many hours per week?
Current Students:
High School
Undergraduate
Graduate
Other
Name of School:
School Address:
Area of Study:
Expected Graduation Date:
Will your work at Tubman be:
For School Credit
If for an internship: Start Date:
Not for School Credit
End Date:
Total hours required:
Employment
Employer
Occupation
Street Address
Department or Suite
City
State
Zip Code
Phone Number
My employer offers a donation-matching program for hours that I volunteer with Tubman.
My spouse/partner's employer offers a donation-matching program for hours that I volunteer with Tubman.
My employer offers a time-off program for volunteers.
ECRA
How did you hear about our volunteer/intern program?
What do you hope to gain from or contribute to Tubman?
References (non-relatives) who have known you for at least 6 months, such as employers, professors, community leaders, long-term
friends, etc.
1. Name:
Relationship:
Phone Number:
Email:
2. Name:
Relationship:
Phone Number:
Email:
3. Name:
Relationship:
Phone Number:
Email:
I certify that all information provided on this application is true and complete. I understand that in completing this application to
be a volunteer/intern with Tubman, it is conditional, based upon the results of specific checks made into the following: (1)
references, (2) criminal history, (3) current employer, if necessary, and (4) driving record, if applicable to the position. I authorize
Tubman to check the references I have listed and verify the information provided. I understand that falsification or significant
omissions of any information may be considered justification for non-acceptance or dismissal if discovered at a later date.
*By entering your full name below this serves as the electronic equivalent of your signature.*
Signature
Date
Signature of parent or guardian (if under 18 years of age)
Date
*** Please see directions below on how to save and attach to e-mail. ***
Directions
How to save:
1. Click "File" located in the upper left corner of the application.
2. Choose "Save As" to PDF... from the list.
3. A window will open on your computer.
4. Click "Save in", choose the location in which you would like to save the PDF file.
5. Click "File name", delete the text in the field and enter the name you want to name the file.
6. Click "Save" button.
Now the PDF is saved under your name to your computer's hard drive as a PDF document.
How to e-mail Tubman a copy of your saved application:
1. Open a new e-mail message.
2. Click "attachment icon" (the paper clip) or "insert" the file by selecting from the drop-down menu.
3. Browse your hard drive or removable disks to locate the file you want to attach.
4. Click “file” to highlight the name, and then click “insert” button.
5. An icon message should now appear indicating that the file has been attached.
6. Click “Send” button and off it goes!